Contact us.
27 August 2015.
The PowerPoint slides that Claire Candelier will use for her tutorial on diabetes are on Dropbox. If you don't have access, send me an e-mail.
The PowerPoint slides that Claire Candelier will use for her tutorial on diabetes are on Dropbox. If you don't have access, send me an e-mail.
53
|
Diabetes & pregnancy.
Claire Candelier
|
54
|
SBA. Coeliac disease &
pregnancy
|
55
|
SBA. Grades of evidence
|
56
|
SBA. Kisspeptin
|
57
|
SBA. Instrumental delivery
|
58
|
SBA. Morphology of skin
definitions
|
59
|
SBA. Neonatal convulsions
|
60
|
SBA. NIPT. Non-invasive
prenatal testing.
|
53. Diabetes & pregnancy.
Claire
Candelier will give a tutorial. You need to download the Powerpoint slides from
the folder “Materials for the tutorials” on Dropbox.
54. SBA. Coeliac disease & pregnancy.
Abbreviations.
AGA: anti-gliadin antibodies
CD: coeliac disease.
EMA: anti-endomysial antibodies.
FGR: Fetal growth restriction.
IgA: immunoglobulin A IgG.
tTGA: anti-tissue
transglutaminase antibody.
Question 1.
Lead-in
What is
coeliac disease?
Option List
A.
|
allergy
to gluten
|
B.
|
malabsorption due to large bowel inflammation
|
C.
|
an auto-immune disorder triggered by gluten sensitivity
causing villous atrophy of the descending colon in individuals with a genetic
predisposition
|
D.
|
an auto-immune disorder triggered by gluten sensitivity
causing villous atrophy of the gastric mucosa in individuals with a genetic
predisposition
|
E.
|
an auto-immune disorder triggered by gluten sensitivity
causing villous atrophy of the small bowel in individuals with a genetic
predisposition
|
Question 2.
Lead-in
What is
the prevalence of coeliac disease in women of reproductive age?
Option List
A.
|
0.1%
|
B.
|
0.5%
|
C.
|
1-2 %
|
D.
|
2-5%
|
E.
|
5-10%
|
Question 3.
Lead-in
Which of the following groups have an increased risk of
CD?
Option List
A.
|
1st.
degree relatives of those with CD
|
B.
|
those with type 1 diabetes
|
C.
|
those
with iron deficiency anaemia
|
D.
|
those
with osteoporosis
|
E.
|
those
with unexplained infertility
|
Question 4.
Lead-in
Which of
the following are features of CD in the non-pregnant population?
Option List
A.
|
abdominal
bloating and pain
|
B.
|
amenorrhoea
|
C.
|
anaemia
|
D.
|
recurrent miscarriage
|
E.
|
unexplained infertility
|
Question 5.
Lead-in
How do
pregnant women with CD present most commonly?
Option List
A
|
anaemia
|
B
|
failure to gain weight in pregnancy
|
C
|
intra-uterine growth retardation
|
D
|
low BMI
|
E
|
no recognised abnormality
|
Question 6.
Lead-in
Which of
the following commonly occur in pregnant women with CD?
Option List
A
|
anaemia
|
B
|
failure to gain weight in pregnancy
|
C
|
intra-uterine growth retardation
|
D
|
low BMI
|
E
|
no recognised abnormality
|
Question 7.
How should the woman with suspected CD be investigated
initially?
Option List
A.
|
jejunal
biopsy
|
B.
|
IgA EMA
|
C.
|
IgA tTGA
|
D.
|
IgA EMA
+ IgA tTGA
|
E.
|
rectal
biopsy
|
Question 8.
Lead-in
Which, if
any, of the following statements are true in relation to the woman due to have
testing for suspected CD?
Option List
A.
|
continue
with a normal diet.
|
B.
|
continue with a normal diet that includes a minimum of
5 gm. gluten daily
|
C.
|
continue with a normal diet that includes a minimum of
10 gm. gluten daily
|
D.
|
follow a strict gluten-free diet for at least 1 month
|
E.
|
follow a strict gluten-free diet for at least 3 months
|
Question 9.
Lead-in
Which of
the following conditions should make consideration of testing for CD sensible?
Option List
A.
|
amenorrhoea
|
B.
|
Down’s syndrome
|
C.
|
epilepsy
|
D.
|
recurrent miscarriage
|
E.
|
Turner’s syndrome
|
F.
|
unexplained infertility
|
Question 10.
Lead-in
How is the
diagnosis of CD confirmed after +ve serological testing?
Option List
A.
|
colonoscopy
|
B.
|
enteroscopy
|
C.
|
gastroscopy
|
D.
|
rectal biopsy
|
E.
|
small
bowel biopsy
|
Question 11.
Lead-in
Which skin
condition is particularly associated with CD?
Option List
A.
|
atopic
eczema
|
B.
|
dermatitis herpetiformis
|
C.
|
dermatitis multiforme
|
D.
|
dermatographia
|
E.
|
psoriasis
|
Question 12.
Lead-in
Which of
the following are likely to be absorbed less well than normally in women with
CD?
Option List
A.
|
carbohydrate
|
B.
|
fat
|
C.
|
folic acid
|
D.
|
protein
|
E.
|
vitamins B12, D & K
|
Question 13.
Lead-in
What is
the appropriate treatment of CD?
Option List
A.
|
antibiotics:
long-term in low-dosage
|
B.
|
azathioprine
|
C.
|
cyclophosphamide
|
D.
|
rectal steroids
|
E.
|
none of the above
|
Question 14.
Lead-in
Which of
the following do not contain gluten?
Option List
A.
|
barley
|
B.
|
oats
|
C.
|
rapeseed oil
|
D.
|
rye
|
E.
|
wheat
|
55. SBA. Grades of evidence.
Lead-in. This question relates
to the Green-top and other RCOG guidelines and how evidence is evaluated and
given importance.
There have
been occasional questions on this, so knowing about it might be worth a mark or
two.
Question 1.
Which of the following statements, if any, are true.
i.
|
CNST requires consultants to follow the advice in GTGs
|
ii.
|
CNST requires consultants to follow the advice in GTGs,
unless the consultant has phoned the CNST to obtain permission for
alternative management
|
iii.
|
Consultants deviating from the advice in a GTG should
send details to the hospital lawyer
|
iv.
|
Consultants are responsible for the decisions they make
about patient care and can choose to deviate from the advice in GTGs.
|
v.
|
A consultant choosing different care for a patient to
that in a guideline should fully document the decision at the time it is
made.
|
vi.
|
Pick the option from the list below that best fits.
|
Option List
|
i
|
|
ii
|
|
iii
|
|
iii + iv
|
|
iv + v
|
Question 2.
Lead-in
Grade A
recommendations have specific requirements. Choose the option from the list
below that best fits.
Option List
|
a positive Cochrane
review is a requirement for a Grade A recommendation
|
|
a Grade A recommendation can be based on
high-quality systematic reviews of case series
|
|
a Grade A recommendation can be based on a single
systematic review or RCT.
|
|
a Grade A recommendation must include a
meta-analysis or systematic review of RCTs
|
|
a Grade A recommendation can be an extrapolation
from studies graded 2++ or better.
|
Question 3.
Lead-in
Which, if any, of the following statements are true about
Grade A recommendations.
i.
|
≥ 1 meta analysis or systematic review can be
sufficient for a Grade A recommendation
|
ii.
|
≥ 1 RCT rated 1++ and applicable to the target
population can be sufficient for a Grade A recommendation
|
iii.
|
a systematic review of RCTs can be sufficient for a
Grade A recommendation
|
iv.
|
studies rated as 1+ which are applicable to the target
population and with consistent results
can be sufficient for a Grade A recommendation
|
Option List
|
i
|
|
i + ii
|
|
i + iii
|
|
all of the above
|
|
none of the above
|
Question 4.
Lead-in
What other grades are
there?
Question 5.
Lead-in
What criteria are
associated with these other grades?
56. SBA. Kisspeptin.
Lead-in.
Pick the best answer from the list below about
kisspeptin.
Option list.
A.
|
is a pheromone released by the hypothalamus during
passionate embraces
|
B.
|
is a digestive enzyme released by the salivary glands
during passionate embraces
|
C.
|
is a digestive enzyme found in human carnivores but not
vegetarians
|
D.
|
does not exist
|
E.
|
is thought necessary for trophoblastic invasion and low
levels have been linked to miscarriage and recurrent miscarriage
|
57. SBA. Operative vaginal delivery. OVD. Based on work done by Aqeela Ayaz.
Question 1.
Lead-in. The use of which of the following is categorised as instrumental
delivery?
A.
|
forceps
delivery
|
B.
|
vacuum delivery
|
C.
|
manual rotation
|
D.
|
delivery with the Odent device
|
E.
|
delivery with Credé’s manoeuvre
|
Option List
1.
|
A + B
|
2.
|
A + B +
D
|
3.
|
A + B +
C + D
|
4.
|
A + B +
D + E
|
5.
|
A + B +
C + D + E
|
Question 2.
Lead-in. The following are included in the recommended classification of
instrumental delivery in GTG26 with which exception?
Option List
A.
|
outlet
|
B.
|
low
|
C.
|
mid with sagittal suture ≤ 450 from the OA
position
|
D.
|
mid with sagittal suture > 450 from the
OA position
|
E.
|
high
|
Question 3.
Lead-in
What is
the incidence of OVD in the UK?
Option List
A.
|
≤ 5%
|
B.
|
>5 % but <10%
|
C.
|
≥10 % but <15%
|
D.
|
≥15 % but <20%
|
E.
|
≥20%
|
Question 4.
Lead-in. What has been the trend in the incidence of OVD in the UK in recent
years?
Option List
A.
|
the
incidence has not changed significantly
|
B.
|
the incidence has increased by 25%
|
C.
|
the incidence has increased by 50%
|
D.
|
the incidence has decreased by 25%
|
E.
|
the incidence has decreased by 50%
|
Question 5.
Lead-in. Which, if any, of the following
features would be grounds for considering OVD?
A.
|
suspected
fetal compromise
|
B.
|
meconium
staining of the liquor
|
C.
|
maternal
pyrexia
|
D.
|
maternal
myotonic dystrophy
|
E.
|
paternal
myotonic dystrophy
|
F.
|
nullipara
who has been “pushing” for 2 hours without evidence of continuing progress
|
G.
|
multipara
who has been “pushing” for 2 hours without evidence of continuing progress
|
Option List
1.
|
all of
the above
|
2.
|
all of the above except B + C
|
3.
|
all of the above except B + C + E
|
4.
|
all of the above except B + C + D + E
|
5.
|
none of the above
|
Question 6.
Lead-in. In relation to consent for OVD with the woman remaining in the delivery
room, which, if any of the following statements are true.
Option List
A.
|
It can
safely be assumed that all women capable of giving consent will have heard of
OVD and no information on the subject needs to be given during antenatal
care.
|
B.
|
It cannot safely be assumed that all women capable of
giving consent will have heard of OVD.
|
C.
|
All
women should be informed during antenatal care about the possibility of OVD
being required.
|
D.
|
All women should be given enough information orally and
in written form during antenatal care to ensure that they can give informed
consent for OVD if required.
|
E.
|
All women should be given enough information orally and
in written form during antenatal care to ensure that they can give informed
consent for OVD and be asked to sign a consent form for OVD to ensure that
there is valid consent if OVD is required.
|
Question 7.
Lead-in. In relation to consent for OVD with the woman transferred to theatre,
which, if any of the following statements are true.
Option List
A.
|
It can
safely be assumed that all women capable of giving consent will have heard of
OVD and no information on the subject needs to be given during antenatal
care.
|
B.
|
It cannot safely be assumed that all women capable of
giving consent will have heard of OVD.
|
C.
|
Verbal
consent suffices.
|
D.
|
Written consent should be obtained.
|
E.
|
Written consent should be obtained before attempting
OVD for both OVD and Caesarean section in case OVD fails.
|
Question 8.
Lead-in. Which, if any, of the following measures can reduce the need for OVD?
A.
|
continuous
support in labour, particularly by a supporter who is not a member of the
labour ward team
|
B.
|
consumption of raspberry tea in labour
|
C.
|
use of erect or lateral position in labour
|
D.
|
delaying pushing in primiparae
|
E.
|
use of a personalised partogram taking account of
height, BMI, ethnicity
|
Option List
1.
|
A + B
|
2.
|
A + B +
D
|
3.
|
A + C +
D
|
4.
|
A + C +
D + E
|
5.
|
A + B +
C + D + E
|
Question 9.
Lead-in. Which, if any, of the following are not contra-indications to the use of
the vacuum extractor?
Option List
A.
|
blood-borne viral infection of mother
|
B.
|
gestational age less than 34 weeks
|
C.
|
asynclitism
|
D.
|
mento-anterior face presentation
|
E.
|
mento-posterior face presentation
|
F.
|
breech presentation
|
Question 10.
Lead-in. What are the pre-requisites for OVD?
There is
no option list – just jot down as many as you can think of.
Question 11.
Lead-in. Which, if any, of the following statements are true when vacuum
extraction (VE) is compared with forceps delivery?
Option List
A.
|
VE has a
higher risk of failed delivery
|
B.
|
VE has
an increased risk of cephalo-haematoma
|
C.
|
VE has
an increased risk of risk of maternal retinal haemorrhage
|
D.
|
VE has
an increased risk of neonatal retinal haemorrhage
|
E.
|
VE has
an increased risk of maternal worry about the baby
|
F.
|
VE has
an increased risk of perineal trauma
|
G.
|
VE has
an increased risk of vaginal trauma
|
H.
|
VE has
an increased risk of Caesarean section
|
I.
|
VE has a
decreased risk of low Apgar score at 5 minutes
|
J.
|
VE has a
decreased risk of the baby needing phototherapy
|
Question 12.
Lead-in. How do forceps and the different types of vacuum extractor rank in the
likelihood of achieving vaginal delivery?
Option List
A.
|
forceps,
hand-held vacuum extractor, metal cup vacuum extractor, soft cup vacuum
extractor
|
B.
|
forceps, hand-held vacuum extractor, soft cup vacuum
extractor, metal cup vacuum extractor
|
C.
|
forceps, metal cup vacuum extractor, hand-held vacuum
extractor, soft cup vacuum extractor
|
D.
|
forceps, metal
cup vacuum extractor, soft cup vacuum
extractor hand-held vacuum extractor
|
E.
|
forceps, soft cup vacuum extractor, metal cup vacuum
extractor, hand-held vacuum extractor
|
Question 13.
Lead-in. What is the role of episiotomy in OVD? Which, if any, of the following
statements are true?
Option List
A.
|
episiotomy
should be done in all primiparous women and all multiparous women who have
had episiotomy before
|
B.
|
episiotomy should not be done unless 3rd. of
4th. degree tears are anticipated
|
C.
|
a policy of liberal use dependent on the operator’s
judgement is advocated in GTG26
|
D.
|
a policy of restrictive use dependent on the operator’s
judgement is advocated in GTG26
|
E.
|
GTG26 does not advise
|
Question 14.
Lead-in. When should attempted OVD be abandoned?
Option List
A.
|
after 3
pulls
|
B.
|
when there is no progressive descent
|
C.
|
when, using moderate traction, there is no progressive descent or delivery
is not imminent after 3 pulls
|
D.
|
when there is no progressive descent or delivery is not
imminent after 3 pulls
|
E.
|
when the operator needs a rest
|
Question 15.
Lead-in
When
should a clinical incident form be submitted after OVD?
Option List
A.
|
all OVDs
|
B.
|
all OVDs that fail to deliver the baby
|
C.
|
all OVDs with an adverse outcome
|
D.
|
all OVDs with an adverse outcome excluding failure to
deliver the baby
|
E.
|
all OVDs with injury to the baby or low 5-minute Apgar
scores
|
Question 16.
Lead-in.
What is
the main reason for medical litigation in relation to OVD
Option List
A.
|
sneezing
during traction
|
B.
|
not abandoning the procedure at the appropriate time
|
C.
|
pulling too hard, too long or too many times
|
D.
|
using more than one instrument
|
E.
|
failure to push the head up when C section is needed to
deliver the baby
|
Question 17.
Lead-in
What
advice is given in GTG26 in relations to sequential use of instruments for OVD.
Option List
A.
|
sequential
use should be avoided if possible
|
B.
|
sequential use increased the risk of trauma to the baby
|
C.
|
sequential use increases the risk of the neonate
needing mechanical ventilation
|
D.
|
sequential use may particularly indicated with outlet
deliveries
|
E.
|
all of the above
|
F.
|
some of the above, but I don’t know which.
|
Question18.
Lead-in. With regard to prophylactic antibiotics for OVD, which, if
any, of the following statements is true?
Option List
A.
|
a broad
spectrum antibiotic + metronidazole should be prescribed and continued for 5
days
|
B.
|
erythromycin + metronidazole or clindamycin should be
prescribed and continued for 5 days
|
C.
|
a broad spectrum antibiotic + metronidazole should be
prescribed initially and the drugs reviewed with the results of rectal and
vaginal swabs taken at delivery. The final drug regime should be continued
for 5 days
|
D.
|
prophylactic antibiotics should be decided with advice
from the bacteriologist to reflect local trends in infecting organism and
antibiotic sensitivity for genital and urinary tract infections.
|
E.
|
prophylactic antibiotics are not required.
|
Question 19.
Lead-in. What prophylaxis should be provided after OVD to reduce the risk of DVT
& VTE
Option List
A.
|
early
mobilisation and good hydration unless the woman has thrombophilia
|
B.
|
early mobilisation, good hydration, graded compression
stockings + warfarin
|
C.
|
early mobilisation, good hydration, graded compression
stockings + LMWH
|
D.
|
early mobilisation, good hydration, graded compression
stockings + warfarin
|
E.
|
none of the above
|
Question 20.
Lead-in. What pain relief should be prescribed after OVD?
Option List
A.
|
aspirin
|
B.
|
aspirin + codeine
|
C.
|
aspirin + codeine + paracetamol
|
D.
|
paracetamol and diclofenac
|
E.
|
paracetamol and ibuprofen
|
Question 21.
Lead-in. Which, if any, of the following would represent minimum bladder care
after OVD in women not having regional anaesthetic blocks?
Option List
A.
|
documentation
of the timing and volume of the first void
|
B.
|
24 hour input / output chart
|
C.
|
self-reporting of voiding difficulty
|
D.
|
physiotherapy-directed strategies to reduce risk of UI
|
E.
|
bladder training
|
Question 22.
Lead-in. Which, if any, of the following would represent minimum bladder care
after OVD in women who have had regional anaesthetic blocks topped up for trial
of OVD?
Option List
A.
|
indwelling
catheter for ≥ 12 hours
|
B.
|
input / output charting to ensure good voiding volumes
|
C.
|
self-reporting of voiding difficulty
|
D.
|
physiotherapy-directed strategies to reduce risk of UI
|
E.
|
bladder training
|
Question 23.
Lead-in. How effective is physiotherapist-provided intervention in reducing UI
after OVD?
Option List
A.
|
it
reduces UI from about 50% to about 40%
|
B.
|
it reduces UI from about 50% to about 30%
|
C.
|
it reduces UI from about 40% to about 30%
|
D.
|
it
reduces UI from about 40% to about 20%
|
E.
|
it doesn’t work at all – it is just a measure to keep
women happy that something is being done
|
Question 24.
Lead-in. After OVD, the pre-discharge
review is best done by whom?
Option List
A.
|
a
midwife with de-briefing skills
|
B.
|
the senior midwife on the postnatal ward
|
C.
|
the doctor who performed the delivery
|
D.
|
the consultant under whose care the woman booked
|
E.
|
the SpR on-call for the postnatal wards
|
Question 25.
Lead-in. GTG26 mentions that OVD can be linked to women developing a PTST
syndrome with severe fear of childbirth. What is this called?
Option List
A.
|
androphobia
|
B.
|
iatrophobia
|
C.
|
parturophobia
|
D.
|
spermatophobia
|
E.
|
tocophobia
|
Question 26.
Lead-in. What advice does GTG give about strategies to reduce the risk of
tocophobia.
Option List
A.
|
midwife
de-briefing is effective but to only a small extent
|
B.
|
operator de-briefing is more effective than midwife
de-briefing
|
C.
|
combined midwife & operatory de-briefing is the
most effective intervention
|
D.
|
fortnightly visits to the same hospital antenatal team
are of proven value
|
E.
|
there are no interventions of proven value
|
Question 27.
Lead-in. What proportion of women at 3 years after OVD indicate that they plan
not to have further children?
Option List
A.
|
5%
|
B.
|
10%
|
C.
|
25%
|
D.
|
50%
|
E.
|
100%
|
Question 28.
Lead-in. What
advice should women be given about future deliveries after OVD?
Option List
A.
|
aim for
normal delivery
|
B.
|
best with planned Caesarean section
|
C.
|
anticipate likely need for OVD
|
D.
|
best not to get pregnant
|
58. SBA. Morphology of skin definitions
Morphology:
definitions of descriptive terms.
For each of the terms below, choose the definition from the option list.
Question 1.
Lead-in
What is the definition of “macule”?
Option List
|
non-palpable lesion < 5mm.
|
|
non-palpable
lesion ≥ 5mm but < 10 mm.
|
|
non-palpable
lesion ≥ 10 mm.
|
|
palpable
lesion < 5 mm.
|
|
palpable
lesion ≥ 5 mm.
|
Question 2.
Lead-in
What is the definition of “patch”?
Option List
|
non-palpable lesion < 5mm.
|
|
non-palpable
lesion ≥ 5mm.
|
|
non-palpable
lesion ≥ 5mm but < 10 mm.
|
|
palpable
lesion < 5 mm.
|
|
palpable
lesion ≥ 5 mm.
|
Question 3.
Lead-in
What is the definition of “papule”?
Option List
|
Non-palpable lesion, >5mm
|
|
Palpable lesion <5mm
|
|
Palpable lesion ≥5mm
|
|
Palpable lesion, wider than it is tall
|
|
Lesion filled with clear fluid
<5mm
|
Question 4.
Lead-in
What is the definition of “plaque”?
Option List
|
Non-palpable lesion, >5mm
|
|
Palpable lesion <5mm
|
|
Palpable lesion ≥5mm
|
|
Palpable lesion that is, wider than it is tall
|
|
Dental lesion that can lead to inflammatory gum disease
|
Question 5.
Lead-in
What is the definition of “nodule”?
Option List
|
Non-palpable lesion, >5mm
|
|
Palpable lesion <5mm
|
|
Palpable lesion ≥5mm
|
|
Palpable lesion that is wider than it is tall
|
|
Lesion filled with clear
fluid ≥ 5mm
|
Question 6.
Lead-in
What is the definition of “papule”?
Option List
|
Non-palpable lesion, >5mm
|
|
Palpable lesion <5mm
|
|
Palpable lesion ≥5mm
|
|
Palpable lesion that is wider than it is tall
|
|
Lesion filled with clear
fluid ≥ 5mm
|
Question 7.
Lead-in
What is the definition of “bulla”?
Option List
|
Palpable
lesion < 5 mm.
|
|
Lesion
filled with clear fluid < 5mm.
|
|
Lesion
filled with clear fluid ≥ 5mm
|
|
Lesion
filled with purulent fluid < 5mm.Purulent fluid filled lesion
|
|
Superficial
structure lined with epithelium.
|
Question 8.
Lead-in
What is the definition of “pustule”?
Option List
|
Palpable
lesion < 5 mm.
|
|
Lesion
filled with clear fluid < 5mm.
|
|
Lesion
filled with clear fluid ≥ 5mm
|
|
Lesion
filled with purulent fluid.
|
|
Superficial
structure lined with epithelium.
|
Question 9.
Lead-in
What is the definition of “cyst”?
Option List
|
Palpable
lesion < 5 mm.
|
|
Lesion
filled with clear fluid < 5mm.
|
|
Lesion
filled with clear fluid ≥ 5mm
|
|
Lesion
filled with purulent fluid < 5mm.Purulent fluid filled lesion
|
|
Superficial
structure lined with epithelium.
|
Question 10.
Lead-in
What is the definition of “vesicle”?
Option List
|
Palpable
lesion < 5 mm.
|
|
Lesion
filled with clear fluid < 5mm.
|
|
Lesion
filled with clear fluid ≥ 5mm
|
|
Lesion
filled with purulent fluid < 5mm.Purulent fluid filled lesion
|
|
Superficial
structure lined with epithelium.
|
59. SBA. Neonatal convulsions
Scenario 1.
Lead-in
Approximately what proportion of neonates will have
convulsions?
Pick one option from the list
below.
Option List
A.
|
0.1%
|
B.
|
1%
|
C.
|
5%
|
D.
|
10%
|
E.
|
15%
|
Scenario 2.
Lead-in
Approximately what proportion of neonatal convulsions
occur in the first week?
Pick one option from the list
below.
Option List
|
5%
|
|
10%
|
|
25%
|
|
50%
|
|
80%
|
Scenario 3.
An audit is done of babies born at term who develop
convulsions in the 12 hours after delivery.
Lead-in
What is likely to be the most common diagnosis?
Pick one option from the list
below.
Option List
|
hypoxic
ischaemic encephalopathy
|
|
intracranial
haemorrhage
|
|
neonatal
epilepsy
|
|
sepsis
|
|
hypoglycaemia
|
Scenario 4.
An audit is done of babies born at < 34 weeks who
develop convulsions in the 12 hours after delivery.
Lead-in
What is likely to be the most common diagnosis?
Pick one option from the list
below.
Option List
|
hypoxic
ischaemic encephalopathy
|
|
intracranial
haemorrhage
|
|
neonatal
epilepsy
|
|
sepsis
|
|
hypoglycaemia
|
Scenario 5.
Lead-in
What
is the approximate risk of neonatal convulsions in babies born at term?
Pick one option from the list below.
Option List
|
<
0.1%
|
|
< 1%
|
|
1%
|
|
2%
|
|
5%
|
Scenario 6.
Lead-in
What
is the approximate risk of neonatal convulsions in babies born at < 34
weeks?
Pick one option from the list below.
Pick one option from the list below.
Option List
|
1%
|
|
5%
|
|
10-15%
|
|
16-20%
|
|
>
20%
|
Scenario 7.
Lead-in
Which
babies are particularly likely to have hypoglycaemic convulsions?
Pick one option from the list below.
Conditions.
|
babies
that are small-for-dates
|
|
babies
that have had intra-uterine growth retardation
|
|
babies
born to mothers taking heroin
|
|
babies
born to mothers using beta2-agonists for asthma
|
|
babies
born to mothers with diabetes
|
Option List
|
1 +
2 + 3 + 4 + 5
|
|
1 +
3 + 4
|
|
1 +
3 + 5
|
|
2 +
3 + 4 + 5
|
|
2 +
4
|
|
2 +
5
|
60. SBA. NIPT. Non-invasive
prenatal testing.
Question 1.
Lead-in
What is the definition of NIPT?
Option List
A.
|
any test to detect fetal anomaly, disease or
significant problem that does not involve invasive testing of the mother
|
B.
|
any test to detect fetal anomaly, disease or
significant problem that does not involve invasive testing of the mother,
excluding TVS
|
C.
|
any test for fetal chromosomal anomaly that does not
involve invasive testing of the mother
|
D.
|
any test for fetal chromosome or genetic anomaly that
does not involve invasive testing of the mother.
|
E.
|
none of the above
|
Question 2.
Lead-in
What is the potential of NIPT using cffDNA and RNA?
Option List
A.
|
description of the full fetal genome
|
B.
|
description of the full fetal genome with the exception
of disorders arising from mitochondrial DNA
|
C.
|
description of the full fetal genome with the exception
of disorders arising from mitochondrial RNA
|
D.
|
description of the full fetal genome and most
structural anomalies
|
E.
|
none of the above
|
Question 3.
Lead-in
Which of the following statements is true?
Option List
A.
|
cffDNA is found in maternal serum in greater quantities
than maternal cell-free DNA
|
B.
|
cffDNA is found in maternal serum in lesser quantities than maternal cell-free
DNA
|
C.
|
the quantity of cffDNA rises throughout pregnancy,
peaking at placental separation
|
D.
|
cffDNA diminishes after placental delivery but remains
detectable for at least 6 weeks
|
E.
|
cffDNA diminishes after placental delivery but remains
detectable for at least 1 year
|
Question 4.
Lead-in
Which, if any, of the following statements are true?
Statements.
1.
|
cffDNA is usually detectable from 4-5 weeks’ gestation
|
2.
|
cffDNA is not usually detectable at gestations < 12
weeks
|
3.
|
the quantity of cffDNA rises throughout pregnancy,
peaking at placental separation
|
4.
|
cffDNA diminishes after placental delivery but remains
detectable for at least 6 weeks
|
5.
|
cffDNA diminishes after placental delivery but remains
detectable for at least 1 year
|
Option List
A.
|
1
|
B.
|
2
|
C.
|
3
|
D.
|
4
|
E.
|
5
|
F.
|
1 + 3
|
G.
|
1 + 4
|
H.
|
1 + 5
|
I.
|
2 + 3
|
J.
|
2 + 4
|
K.
|
2 + 5
|
Question 5.
Lead-in
Which, if any, of the following
statements is true about cffDNA in maternal blood?
Statements.
1.
|
cffDNA originates in the
placenta, not the fetus
|
2.
|
cffDNA originates in fetal squames
|
3.
|
cffDNA originates in fetal blood cells
|
4.
|
cffDNA occurs in maternal blood due to trans-membrane
osmosis
|
5.
|
cffDNA occurs in maternal blood due to feto-maternal
transfusion
|
Option List
A.
|
1
|
B.
|
2
|
C.
|
3
|
D.
|
4
|
E.
|
5
|
F.
|
1 + 4
|
G.
|
2 + 4
|
H.
|
2 + 5
|
I.
|
3 + 5
|
Question 6.
Lead-in
Which. if any, of the following statements are true?
Statements.
1.
|
tests using cffDNA are based on detecting
paternally-derived fetal DNA in maternal blood.
|
2.
|
tests using cffDNA are based on detecting maternally-derived
fetal DNA in maternal blood.
|
3.
|
tests using cffDNA are based on detecting DNA from the
fetal Y chromosome.
|
4.
|
tests using cffDNA may involve shotgun sequencing.
|
5.
|
tests using cffDNA may involve shotgun nuptials.
|
Option List
A.
|
1
|
B.
|
2
|
C.
|
3
|
D.
|
4
|
E.
|
5
|
F.
|
1 + 4
|
G.
|
1 + 5
|
H.
|
2 + 4
|
I.
|
2 + 5
|
J.
|
3 + 4
|
K.
|
3 + 5
|
Question 7.
Lead-in
Which. if any, of the following statements are true?
Option List
A.
|
detection of the SRY sequence
in cffDNA means that the fetus is female
|
B.
|
detection of the SRY sequence in cffDNA means that the
fetus is male
|
C.
|
detection of the SRY sequence in cffDNA means that the
fetus is male unless it has a DSD
|
D.
|
detection of the SRY sequence in cffDNA means that the
fetus has Klinefelter’s syndrome
|
E.
|
detection of the SRY sequence in cffDNA means that the
fetus has 45X0/46XY mosaicism.
|
Question 8.
Lead-in
Which. if any, of the following statements are true?
Option List
There is none.
A.
|
Rhesus D status can be determined accurately from 12
weeks’ gestation using cffDNA
|
B.
|
Rhesus D pseudogene is more common in Africans than
Caucasians
|
C.
|
People with the RhD pseudogene are at risk of
isoimmumisation.
|
D.
|
People with the RhDu blood type may be identified as
Rh-ve or Rh+ve on routing testing
|
E.
|
People with the RhDu blood type are particularly prone
to isoimmunisation
|
Question 9.
Lead-in
Which. if any, of the following statements are true in relation to
cffDNA in maternal blood?
Option List
A.
|
Checking the fetal RhD status
is best left until > 16 weeks’ gestation
|
B.
|
Checking the fetal Kell status is not yet routinely
available
|
C.
|
Checking the fetal Kell status is best left until >
20 week’s gestation
|
D.
|
Routine screening of Rh –ve women for fetal RhD status
reduces the use of RAADP by up to 10%
|
E.
|
Routine screening of Rh –ve women for fetal RhD status
reduces the use of RAADP by up to 40%
|
Question 10
Lead-in
List the other situations in which cffDNA in maternal serum can be used
for clinical benefit.
Other questions.
1. cffDNA levels in maternal blood are raised
in pregnancies affected by Down’s syndrome. T / F
2. screening for T 21 using cffDNA
has both sensitivity and specificity close to 100%. T / F
3. What is the value of cffDNA in women at
risk of having a baby with CAH?
4. How might cffDNA be used to screen for
conditions such as cystic fibrosis?
5. What is the role of amniocentesis if a
cffDNA screen for a condition such as cystic fibrosis proved +ve?
6. cffDNA screening for achondroplasia and
thanatophoric dysplasia is now available on the NHS for women at risk of an
affected baby. True / False
7. What is meant by “contingent” screening
using cffDNA in relation to Down’s syndrome?
8. What is an “allele”?
9. What is a “wild-type” allele?
10. What is the alternative to a “wild-type”
allele?
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